Surgical drain



June 1 4, 1932. a NN 1,863,057 I SURGICAL DRAIN Filed March 3, 1930INVEN TOR EEmrqEAJnnEs- @Znwmeww WITNESS:

Patented June 14, 1932 GEORGE A. INN ES, OF PHILADELPHIA, PENNSYLVANIASURGICAL DRAIN Application filed March 3, 1930. Serial No. 432,609.

This invention relates to an instrument for surgical uses andparticularly to a surgical drain.

It is not infrequent that children are born without an anal aperture,although the rectal pouch is in most cases present.

It, therefore, devolves upon the surgeon to create an anus by cuttingthe tissues in the region where the anus should normally be forming ananal canal communicating with the rectal pouch.

My invention has for its object the provision of an instrument whichsustains the anal wall in open position and which engages 5 the rectalpouch immediately surrounding the ano-rectal line so as to prevent theinstrument from being dislodged from its proper position.

A further object of the invention is to provide such an instrumentwhich, when collapsed, may be readily inserted through the anal apertureand which, having been so inserted, may be readily adjusted so as toprevent its removal from position.

Still a further object of the invention is to provide an instrumentwhich will sustain the anal wall and through which drainage is providedfrom the rectal pouch.

Still a further object of the invention is 3-0 to provide an instrumentsuch as above described and through which the affected parts of therectal pouch may he medicated without dislodging or even adjusting theinstrument.

Still another object of the invention is to provide such an instrumentin a self-contained unit which is easy to manufacture and which, whenmanufactured and assembled, will, on account of its few parts, beunlikely to get out of order or become broken. Still another object ofthe invention is to provide a surgical instrument which can be used witha finger cot or the like to hold the rectal pouch in position.

The invention also has for an object the production of a surgicalinstrument which may be inserted into any incision and which will permitthe introduction of a salt solution or any medicament and at the sametime will provide means for the escape of gases from within.

l/Vhile the invention herein is described largely in connection withrectal operations, it will be understood that the instrument is designedfor uses wherever its applicability recommends it.

According to the invention the surgical drain is provided with a tubularbody having a limiting plate on the outer end thereof, the inner endacting as means against which one end of an expansible member rests, anda cap confining the other end of said expansible member and adjustablyconnected to said body whereby the expansible member may be expanded orcollapsed.

The cap may be provided with holes or perforations communicating throughthe body with the atmosphere. The means which connects the body to thecap may be pro- 7%? vided with a channel through which medicinaltreatments may be inserted beyond and around the cap and eXpansiblemember.

The drawing illustrates an embodiment of the invention and the viewstherein are as follows:

Figure 1 is a dotted view showing the relative locations of the anus andrectal pouch in the human body, said parts being shown in dot-ted linesand with the improved surgical drain applied and expanded,

Figure 2 is a longitudinal sectional view of the instrument,

Figure 3 is a front view of the same,

Figure 4 is a cross-sectional view taken on the line 4-4 of Figure 2,

Figure 5 is a side view of the member connecting the body and the cap,and

Figure 6 is a side view of the instrument, showing a finger cot coveringthe same.

In describing the surgical drain in its use in connection with rectaloperation, 11 represents the anal canal communicating with the rectalpouch 12 where the anal canal is prop- M erly formed. The wall thereofis normally supported by the internal and external sphincter muscles andthe line separating the rectal pouch from the anal canal and which isindicated by the numeral 13 is known as re the ano-rectal line, whilethe outer edge 14: of

the anal canal is known as the anus or anal margin.

Referring now to Figure 2, the drain comprises a tubular body 16terminating at its outer end in a plate or wing 17 which is adapted tobe pressed into line with the anal margin when the instrument is used inrectal work, andagainst the edge of an incision when the instrument isused elsewhere.

Across the outer end of the tubular body 16 is a bridge 18:,throughwhichextends the operating tube 19 rotated by means of the operatingknob 21 secured to the outer-end thereof and whose inner end is adjacentthe outer face of the bridge 18, while a collar 22 ishprovided. onsaidoperating tube on the other side of said bridge so that'saidbridgeisxmaintained between-the inner end'of said operatingfknobtand saidcollar.

Atapoint near the inner end of the tubular bodyv 16 there is anotherbridge .23 and this bridge is provided with an opening 24 throughwhichthe connecting screwv26 extends and said opening is also providedwith a keyway. slotz27through .which the. key 28, formed integral withsaid screw, .or braised or otherwise fastenedthereon, may slide. Thescrew 26 is tubular having a. passageway 30 extendingentirely throughthe same.

The inner end'of the, screw 26 is threaded, as at 29, and these threadsengage internal .threads 31in the operating tube 19 and the .e-ndofsaidscrew 26 is .peened over asat 32 in order to prevent the-endthereoffrom passing beyondtheinner limit of thethreads 31 in the. operatingtube 19.

It, therefore, follows that, as shown in Figure'2, thescrew-26 and tube19 are in their .greatestelongated positionfland the limit" for reducingthe length of such parts will be reached'when the inner end of the key28 strikesagainsttheinnertend ofthe operating tube, 19.

"It-may.be-. said, therefore, thatthe adjustment ofathe instrument'restsbetween these two points. 7

Theextremeinner end of the'tubularbody 16 forms with the bridge23asupport for one end ofia fiexible expansiblezmember 33, while theother: end rests within the cup-like recess 34 in the cap 36. This caphasacentral threadedopening 37 which screws onto the outer threaded end38 'of'fthe'connecting-screw 26 and -may be removed for replacement ofthe expansible member 33.

In the position shown in Figure 2 the expansible member isin itsextremecollapsed position and is in the formLof a piece of rubbertubingwhosewall'is of suiiicient thickness to' provide the necessary resilientrigidity for preventing the-instrument from being re- 'moved'fromia'position, such for instance as thatshown in Figural, andtosupport anatomical parts, such for instance as the rectal cavity shownin Figure 1.

Of course, while rubber tubing is shown, flexible metal tubing, adjacentmetal strips or the like may be used with equal efficiency.

This eXpansible tube 33 is provided with slits 39 extending entirelythrough the wall of'the same and such slits are of a length equal to thelength between the inner end of the tubular body 16 and the inner end ofthe cap 36'when such parts are in their extreme positions, such as shownin Figure 2.

It will, of course, be understood that when the operating knob 21. isturned so that the connecting screw 26-is drawn into the same, the cap36 will be drawn toward the body 16andthe ribs or sections of. theexpansiblc tube will assume a position as illustrated by Figure 1.

The outer opening ll of the operating tube 19, where it is surrounded bythe operating knob 21,.is tapered and of just suiiicient size to fit thetapered nozzle ofa standard Luer syringe for introducing medicinethrough the operating. tube 19 and passageway 30.

The cap 36 is provided with a'plura-lity of openingsl-EZ extendingthrough the same so that there is provided,.in addition to the openingsbetween the ribs of theexpansible member, a complete passageway throughthe tubular. body 16 to the atmosphere.

, The latter mentioned openings are ofparticular advantage when, forinstance, a finger cot is applied over the instrument, as shown byFigure 6.

When the cot 40 is rolled onto the instru ment, the outer end-is pinchedor torn off so as to leave the broken edge 4-3 and 1 -5 represents therubber reinforcement of the cot.

lVhen the ex'p'ansible member 33 is 0.".- panded, as shown inFigure'L'the cot will provide a continuous wall which maybe properlydressed with ointments and the like, and which will act as a tampon forthe rectal pouch and will, in case of hemorrhages, ofttimes staunch theflow of blood, in addition to providing a complete wall for supportingthewall of the rcctal'pouch.

Since the openings between the sections of the expansible member are nowclosed, observation of the conditionof the operative field may bemade'because any further flow of blood or the like will pass downthrough the openings-.4i:2, throughthe cot l0 and through the tubularbody 161to theexterior of the inthrough said drainage conduit, saidirrigating conduit being sectional, said sections being adjustable tovary the length of said irrigating conduit.

' 2. A surgical instrument comprising a laterally expansible drainageconduit, and an irrigating conduit extending entirely through saiddrainage conduit, said irrigating conduit being sectional, said sectionsbeing adjustable to vary the length of said irrigating conduit, saidvariation controlling the expanding of the drainage conduit.

3. A surgical instrument comprising a laterally expansible drainageconduit, and an irrigating conduit extending entirely through saiddrainage conduit, said irrigating conduit being sectional, said sectionsbeing adjustable to vary the length of said irrigating conduit, saidvariation controlling the expanding of the drainage conduit, andmaintaining said expansion when attained.

4. A surgical instrument comprising a lat erally expansible drainageconduit, and an irrigating conduit extending entirely through saiddrainage conduit, said irrigating conduit bein sectional, said sectionsbeing movably ad ustable to vary the length of said irrigating conduit,the adjustable movement controlling the expanding of the drainageconduit, and an elastic envelope for said conduit, said elastic envelopebeing perforated also in registry With the outlet port of the irrigatingconduit.

5. A surgical instrument comprising a laterally expansible drainageconduit, and an irrigating conduit extending entirely through saiddrainage conduit, and an elastic envelope for said conduit. saidenvelope being imperforate about the expansible part and perforate atthe locus of the irrigating conduit.

6. A surgical instrument comprising a laterally expansible drainageconduit, and an irrigating conduit extending entirely through saiddrainage conduit, and an elastic envelope for said conduit. saidenvelope being imperforate about the expandible part and perforated inregistry with the inlet ports.

7 A surgical instrument comprising a laterally expansible drainageconduit, and an irrigating conduit extending entirely through saiddrainage conduit, and an elastic envelope for said conduit, saidenvelope being imperforate about the expandible part and perforated inregistry with the inlet ports, said elastic envelope being perforatedalso in registry With the outlet port of the irrigating conduit.

8. A surgical instrument comprising a laterally expansible drainageconduit, and an irrigating conduit extending entirely through saiddrainage conduit, said irrigating conduit being sectional, said sectionsbeing adjustable to vary the length of said irrigating conduit, and anexternally positioned manually actuated part for adjusting the sections.

9. A surgical instrument comprising a laterally expansible drainageconduit, and an irrigating conduit extending entirely through saiddrainage conduit, said irrigating conduit being sectional, said sectionsbeing adjustable to vary the length of said irrigating conduit, and anexternally positioned manually actuated part for adjusting the sections,said manually actuated part providing connecting means for introducingirrigating fluid.

10. A surgical instrument comprising a laterally expansible drainageconduit, and an irrigating conduit extending entirely through saiddrainage conduit, said irrigating conduit being sectional, said sectionsbeing movably adjustable to vary the length of said irrigating conduit,and an externally positioned manually actuated part for adjusting thesections, said manually actuated part providing connecting means forintroducing irrigating fluid, the adjustable movement controlling theexpanding of the drainage conduit.

11. A surgical instrument comprising a laterally expansible drainageconduit, and an irrigating conduit extending entirely through saiddrainage conduit, said irrigating conduit being sectional, said sectionsbeing movably adjustable to vary the length of said irrigating conduit,and an externally positioned manually actuated part for ad justing thesections, said manually adjusted part providing connecting means forintroducing irrigating fluid, the adjustable movement controlling theexpanding of the drainage conduit, and maintaining said expansion Whenattained.

12. A surgical instrument comprising a laterally expansible drainageconduit, an irrigating conduit extending entirely through said drainageconduit, and an elastic envelope for said draining conduit, saidenvelope being imperforate about the expandible part, said irrigatingconduit being sectional for longitudinal adjustment.

13. A surgical instrument comprising a laterally expansible drainageconduit, and an irrigating conduit extending entirely through saiddrainage conduit, and an elastic envelope for said conduit, saidenvelope being imperforate about the expandible part and perforated inregistry with the inlet ports, said irrigating conduit being sectional.

14. A surgical instrument comprising a laterally expansible drainageconduit, an irrigating conduit extending entirely through said drainageconduit, and an elastic envelope for said drainage conduit, saidirrigating conduit being sectional, said sections being adjustable tovary the length of said irrigating conduit.

15. A surgical instrument comprising a let =erall 'ex ansible draina econduit and an lope for said conduit, said envelope being imperforateabout the expandible part, said irrigatingconduit being sectional, saidsections'being adjustable to vary the length of said irrigating conduit.

16. A surgical instrument comprising a laterally expansible drainageconduit, and an irrigating conduit extending entirely through saiddrainage conduit, and an elastic envelope for said conduit, saidenvelope being imperforate about the expandible part and perforated'inregistry with the inlet ports, said irrigating conduit being sectional,said sections being adjustable to vary the length of said irrigatingconduit.

17. A surgical instrument comprising a laterally'expansible drainageconduit, an irrigating conduit extending entirely through saiddrainage-conduit, an elastic envelope for said conduit, said irrigatingconduit being sectional, said sections being movably adjustable to varythe length of said irrigating conduit, and means positioned inaccordance with the adjustable movement-controlling the expanding of thedrainage conduit.

18. A surgical instrument comprising a laterally expansible drainageconduit, an irrigating conduit extending entirelythrough said drainageconduit, an elastic envelope for said conduit, and means positioned inaccordance with said envelope being imperforate about the expandiblepart, said irrigating-conduit being sectional, said sections beingmovable adjustable to vary the length of said irrigating conduit, theadjustable movement controlling the expanding of the 'dra-inage'conduit.i 19. A surgical lnstrument comprising a laterally expansible drainageconduit, an irrigating conduit extending entirely through said drainageconduit, an elastic envelope for said conduit, said envelope beingimperforate about the expandible part and perforated in registry withthe inlet ports, said irrigating conduit being sectional, said sectionsbeing movably adjustable to vary the length of said irrigating conduit,and means positioned in accordance with the adjustable movementcontrollingthe expanding of the drainage conduit, and maintaining saidexpansion when attained. I

20, A surgical instrument comprising a laterally expansible drainageconduit, an irrigating conduit extending entirely through said drainageconduit, an elastic envelope for said drainageconduit, said envelopebeing imperforate about: the expandible part and perforated in registrywith the inlet ports, said irrigating conduit being sectional, saidsections being movably adjustable to vary the length of said irrigatingconduit, and

means positioned" in accordance with theadjustable-'movementcontrollingthe expanding of the drainage conduit,and maintaining said expansion when attained, said elastic GEORGE A.INNES.

